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General NPI Number Information
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NPI Number | 1659911584
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Entity Type | Individual
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Provider Name | SARA KAY VAN DYK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 1390 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-4001
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Country | US
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Telephone | 651-232-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 4755 PARK COMMONS DR APT 542
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-5141
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Country | US
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Telephone | 262-573-0550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60933195
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105522
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License Number State | MN
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